CMSFORM.ORG – CMS 1763 – Request for Termination of Premium Hospital Insurance of Supplementary Medical Insurance – If you’re enrolled in Medicare’s premium Hospital Insurance (HI) or Supplementary Medical Insurance (SMI), there may come a time when you want to discontinue the coverage. In such cases, you’ll need to complete form CMS-1763 – Request for Termination of Premium Hospital Insurance or Supplementary Medical Insurance.
But before you fill out this form, it’s important that you understand what it means and how it can impact your healthcare coverage. This article will guide you through everything that you need to know about CMS-1763 and its implications so that you can make an informed decision about whether to terminate your HI or SMI coverage.
Download CMS 1763 – Request for Termination of Premium Hospital Insurance of Supplementary Medical Insurance
| Form Number | CMS 1763 |
| Form Title | Request for Termination of Premium Hospital Insurance of Supplementary Medical Insurance |
| Published | 2022-01-31 |
| O.M.B. | 0938-0025 |
| File Size | 101 KB |
What is a CMS 1763?
When it comes to Medicare, beneficiaries have several options for coverage. One of these options is Premium Hospital Insurance (Part A) and Supplementary Medical Insurance (Part B). While these two parts work together to provide comprehensive coverage, circumstances may arise where a beneficiary no longer needs or wants Part B coverage. This is where CMS 1763 – Request for Termination of Premium Hospital Insurance of Supplementary Medical Insurance comes in.
CMS 1763 is a form that allows beneficiaries to terminate their Part B coverage while keeping their Part A coverage. However, it’s important to understand the implications of terminating this coverage and whether it’s the right decision for your healthcare needs.
Where Can I Find a CMS 1763?
If you are looking for a CMS 1763 form, there are several ways to find it. One option is to visit the official website of the Centers for Medicare and Medicaid Services (CMS) and search their forms library. The CMS 1763 form can also be found on other government websites such as the Social Security Administration or through your state’s Department of Health and Human Services. Additionally, you may be able to obtain a copy from your healthcare provider or insurance company.
When filling out the CMS 1763 form, it is important to provide accurate information about your Medicare coverage and reasons for terminating your premium hospital insurance or supplementary medical insurance. You should also ensure that all required fields are filled in correctly, including dates and signatures. After completing the form, make sure to keep a copy for your records before submitting it according to the instructions provided on the form.
Overall, obtaining and properly filling out a CMS 1763 form is an important step in managing your Medicare coverage and ensuring that you receive appropriate benefits based on your individual needs. Whether accessing it online or through other sources, taking time to complete this process can help save you money while ensuring quality care as needed.
CMS 1763 – Request for Termination of Premium Hospital Insurance of Supplementary Medical Insurance
CMS 1763 is a form that Medicare beneficiaries can use to request the termination of their premium hospital insurance or supplementary medical insurance. The form is necessary for those who wish to cancel their coverage for any reason, such as a change in circumstances or no longer needing the coverage.
The CMS 1763 form must be completed and submitted to the Social Security Administration (SSA) along with proof of enrollment in another health plan. Once approved, the termination of premium hospital insurance or supplementary medical insurance will take effect on the first day of the following month.
It’s important for beneficiaries to understand that terminating their Medicare coverage may result in penalties if they decide to re-enroll at a later date. It’s recommended that individuals consult with a Medicare specialist before making any changes to their coverage. Overall, CMS 1763 provides an easy and straightforward process for those wishing to terminate their Medicare coverage.
CMS 1763 – Example
